Tarsal Tunnel Decompression

At Illinois Foot & Ankle Clinic, we offer advanced treatments for a variety of foot and ankle conditions, including tarsal tunnel decompression. This procedure is critical to relieving pain and restoring function in cases involving nerve compression in the tarsal tunnel.

Tarsal tunnel decompression is a surgical procedure designed to relieve pressure on the nerve structures that pass through the tarsal tunnel, especially in the area of the lateral tibial nerve. The main goal of decompression is to restore normal function to the nerve structures passing through this narrow canal. By releasing the nerves from the pressure caused by surrounding tissues, we aim to eliminate pain, numbness and other symptoms associated with tarsal tunnel syndrome.

The treatment procedure is based on releasing nerve structures from the pressure they are under as a result of compression. Surgical access to the tarsal tunnel allows us to free the nerves by removing or dissecting the tissues that may be putting pressure on them. This may involve removing parts of the tendons that communicate with the tunnel, or dissecting tight ligaments that create pressure on the nerves.

When Is Tarsal Tunnel Decompression Recommended?

Tarsal tunnel decompression is an effective procedure that is often recommended for patients suffering from a variety of symptoms and conditions related to nerve compression in the bony-fibrous canal region. The clinical presentation may manifest:

• severe pain, burning, or numbness in the foot, especially on the bottom, instep, and side of the foot. These symptoms may get worse when walking or standing.
• a tingling or tingling sensation in the foot;
• sensitivity to touch or wearing shoes;
• a sensation of numbness and weakness in the muscles of the soles of the toes;

Symptoms may worsen after exertion on the leg, especially after standing still for long periods of time or prolonged walking.

Various conditions can provoke such symptomatology:

1. Tarsal tunnel syndrome: compression of nerves and tendons in the tarsal canal.
2. Morton's neuromas: neural tumor formation in the region of the tarsal tunnel.
3. Diabetic neuropathy.
4. Reduction of the arch of the foot in flat feet.
5. Fractures, sprains, or other injuries to the ankle can damage the canal and cause nerve compression.
6. Rheumatoid arthritis or other types of arthritis can lead to inflammation and narrowing of the tunnel.

If you are experiencing the above symptoms, see a specialist for a detailed evaluation and recommendations. The decision to have surgery to remove the tarsal tunnel of the foot should be made by a physician after a thorough examination and evaluation of all factors.

Preparation for Surgery

Before the surgery, you should undergo an examination and get recommendations and detailed information about the procedure from your doctor.

Consultation

During the consultation, the doctor will evaluate the clinical symptoms and perform a palpatory examination and the necessary tests such as EMG (Electroneuromyography) to detect the nerve conduction velocity or Tine-Goldberg test to detect possible compression or pinching of the nerve.

Laboratory and instrumental examinations may include:

• Standard urine and blood tests;
• X-rays or CT scan to identify skeletal abnormalities that may be causing compression of the posterior tibial nerve;
• MRI and ultrasound can be helpful in identifying inflammation, tendon damage or increased vascularity.

Recommendations:

1. Do not eat or drink for 6–8 hours before surgery. This is to keep your stomach empty during anesthesia.
2. Stop taking certain medicines. You will need to stop taking some medicines that may affect blood clotting or interact with anesthesia.

Organize help after surgery. You will need help from a friend or family member to get home after surgery and with daily activities for the first few days.

The Tarsal Tunnel Decompression Procedure

Decompression surgery of the tarsal tunnel can be performed in two ways: open surgery and endoscopic surgery.The main steps of this procedure are:

Patient Preparation.

• The patient is subjected to general or local anesthesia.
• The surgeon creates small incisions on the inside of the ankle.

Endoscope insertion.

• The surgeon inserts an endoscope (a thin tube with a video camera) through the incision.
• The endoscope allows visualization of the internal structures of the nerve canal.

Nerve identification.

• Using an endoscope, the surgeon determines the position of the tibial nerve inside the tunnel.

Decompression.

• With specialized instruments, the surgeon widens the canal, freeing the nerve from pressure.
• The endoscope allows for precise control of the process and minimizes damage to surrounding tissues.

Wound closure.

• Incisions are closed with sutures or special adhesives.

Post-operative care:

• A bandage is applied to the patient.
• It is recommended that you rest and follow your doctor's instructions.

Endoscopic tarsal tunnel surgery provides faster recovery, less postoperative pain, and more cosmetic results than traditional methods.

Recovery and Aftercare

After tarsal canal surgery, it is important to follow the guidelines for a successful recovery.

Recovery process

For the first few days after surgery, it is recommended that you rest by raising your leg above the level of your heart. This will help reduce swelling and speed healing. You will need 2 to 4 weeks to fully recover from surgery. During this time, you will need to:

• Wear special shoes to help you walk without overloading the foot;
• avoid excessive stress on the foot and gradually increase walking time;
• do exercises to help improve ankle mobility and strengthen the muscles in the foot;
• applying ice to the foot to help reduce swelling and pain after tarsal surgery;
• take prescribed medications (pain relievers and anti-inflammatory drugs);
• to monitor wound healing.

Care recommendations:

1. Do not wet the wound for 2–3 days after surgery.
2. Clean the wound with soap and water twice a day.
3. Apply the ointment that has been prescribed by your doctor to the wound.
4. Change the dressing at least twice a day.
5. Monitor your well-being and let your doctor know of any complications, such as heel pain after tarsal tunnel perforation, swelling, redness, or discharge from the wound.

Your doctor will schedule your follow-up appointments to assess healing and adjust your treatment.

Why Choose Our Clinic?

Illinois Foot & Ankle Clinic is a well-known clinic specializing in the treatment of foot and ankle disorders. Our advantages:

1. High level of qualification of specialists with many years of experience.
2. We utilize the most advanced therapies available.
3. We offer a personalized approach to each patient.
4. The clinic is equipped with the most modern equipment for the diagnosis and treatment of foot and ankle diseases. This allows us to perform operations with high precision and minimal trauma.
5. We offer a comfortable stay in our clinic and make sure that your recovery from surgery goes as smoothly as possible.

At Illinois Foot & Ankle Clinic, we take pride in offering our patients advanced treatments utilizing the latest technology and techniques. Our team, led by leading specialist Dr. Alex Yanovskiy, DPM, is here to help you return to an active life without limitations or pain. Make an appointment for a consultation at the Illinois Foot & Ankle Clinic. Tel. (847) 298-3338, Des Plaines. We can help you get rid of pain and get your feet back to health.